The intimal surface of the blood vessel in vivo is subject to shear stress resulting from blood flow, which in most of the circulation, at least at rest, is laminar. Turbulence can occur at bifurcations, especially those of the large arteries, and where vessels curve significantly. Shear stress is a frictional tangential force exerted at the fluid-intimal interface in the long axis of the vessel. It is now known that hemodynamic shear stress can influence a large variety of biological processes in endothelial cells, which vary from those with a short response time, just a few milliseconds, such as the opening of ion channels, to those that change over a period of minutes to several hours, for example, endocytosis and cytoskeleton rearrangement, and those features that alter much more slowly, such as cell shape and stiffness. In addition to these types of changes, there are suggestions that flow acting through shear stress may be responsible for several basic attributes of the vasculature, including the relative size and diameter of the components of a branching vascular system. In this symposium on the flow regulation of the blood vessel, the first presentation dealt with optimality principles that appear to govern the dimensions of the vasculature, in particular the geometry of the arterial branching and the role of shear stress. An optimally designed system is one that requires the least metabolic work to perform its function.(ABSTRACT TRUNCATED AT 250 WORDS)